DiabesityJulian Whitaker, MD If you’re seriously overweight, maintaining a normal blood sugar level is like trying to squeeze a 42-inch waist into a pair of size 36 pants—it’s next to impossible. More than 90 percent of people with type 2 diabetes are overweight. In fact, the link between diabetes and obesity is so strong that it’s led to the coining of a new word, diabesity. Unfortunately, the treatments that conventional physicians often use to control glucose actually increase weight gain, making it more difficult to manage blood sugar levels and leading patients with diabetes down a dark path toward painful neuropathy, kidney disease, vision problems, and cardiovascular disease. You may not realize it, but diabetes is the number-one cause of blindness, leg amputations, and kidney transplants, and it dramatically increases risk of heart attack. But there’s a bright side. For most of you, getting a handle on weight is all it takes for blood sugar to normalize, complications to fade away, and overall health to rebound. And if you’re overweight but haven’t yet been diagnosed with diabetes, losing weight can nip it in the bud. Insulin and Obesity: The Vicious Cycle Let’s take a look at why obesity and diabetes march in lockstep. Type 2 diabetes, which affects 95 percent of all diabetics, is caused by insulin resistance. In people with this condition, the beta cells in the pancreas make plenty of insulin, the hormone that moves glucose from the blood into the cells, but the cells are unresponsive to insulin’s actions. This leads to a rise in blood sugar. The pancreas responds by churning out more insulin, and the net result is elevated levels of both glucose and insulin. Obesity throws fuel on the fire. Adipose tissue (fat), especially in the abdominal area, releases fatty acids that impair beta-cell function and insulin sensitivity. It also produces immune cells that lead to chronic, low-grade inflammation. Inflammation, in turn, increases insulin resistance and risk of diabetes. Fat cells also secrete hormones—so many, in fact, that some experts actually refer to adipose tissue as an endocrine organ. One of these hormones is leptin. Although leptin is best known for its governing effects on appetite and energy metabolism, researchers from Boston’s Joslin Diabetes Center recently discovered that it also has direct effects on insulin secretion and beta-cell growth. At the same time, the high levels of insulin that are characteristic of type 2 diabetes promote weight gain. That’s because insulin is the body’s primary fat-storage hormone—it ushers fat as well as glucose into the cells. So the higher your insulin level, the greater your potential weight gain. The best way to break this cycle is to shed excess weight. Yet most physicians offer interventions that do exactly the opposite. Overuse of Insulin in Type 2 Diabetes Although most people think injected insulin is reserved for type 1 diabetes, more than one in four people with type 2 diabetes use insulin. And, in most of those cases, it makes things worse. A patient of mine, let’s call him Bill, had type 2 diabetes for 10 years prior to coming to the clinic. At the time of diagnosis, his physician started him on a drug that stimulates insulin production. It worked for a while, but slowly and surely his blood sugar—and his weight—began to increase. His doctor responded by upping his medication dose. Again, his levels improved for a time, but eventually both his blood sugar and his waistline inched up. After a time, Bill was no longer able to keep his diabetes under control with oral drugs, so his doctor prescribed a low dose of insulin. Over the next few years, his insulin dose was periodically ratcheted upward to keep pace with his rising blood sugar levels, and with every increase, he gained more and more weight. When I first saw Bill, he was taking 100 units of insulin daily and had put on 100 pounds! Folks, that’s just bad medicine. Bill’s diabesity, which was contributing to a number of health problems, was clearly exacerbated by insulin. My treatment plan was simple. I stopped his insulin completely and started him on a proper diet, exercise program, and targeted nutritional supplements. It took several years, but Bill lost those 100 extra pounds, and his blood sugar normalized without any medication at all. Insulin Use Increases Risk of Hypertension Weight gain isn’t the only downside of insulin use. In a recent study, Taiwanese researchers looked at more than 87,000 patients with type 2 diabetes who were treated with either oral drugs or insulin. They found that patients using insulin had a higher prevalence of hypertension (61.3 versus 53.9 percent), and the longer they used it, the greater their risk. This is not surprising when you consider insulin’s activities beyond nutrient storage. Injected insulin increases sodium retention and stimulates the sympathetic nervous system. It induces oxidative stress, leading to free-radical damage that impairs the function of the endothelial cells lining the arteries. It also has growth factor–like activity that thickens blood vessels and increases risk of atherosclerosis. People with diabetes are already at dramatically increased risk of hypertension and cardiovascular disease. The last thing they need is a treatment that amplifies this risk—especially when weight loss and other natural therapies accomplish the desired result. Oral Drugs Promote Weight Gain Some oral diabetes drugs are problematic as well. Doctors routinely insist that their diabetic patients lose weight, but then give them drugs that make doing so nearly impossible. Sulfonylureas such as glyburide (Micronase, Diabeta) and glipizide (Glucatrol), which promote insulin release in the pancreas, are notorious for causing weight gain. These drugs also carry a warning about increased risk of death from cardiovascular disease. Avandia, which has been in the news since it was revealed that this drug dramatically increases risk of heart attack and death, also causes weight gain. A study of more than 4,000 patients recently diagnosed with type 2 diabetes found that those taking Avandia gained an average of 10 pounds over five years, compared to a loss of six pounds among those taking metformin and a gain of three pounds for those on glyburide. Lose Weight, Lose Diabetes Granted, diet, exercise, and other non-drug treatments for diabesity require effort on the part of both physician and patient. But what a payoff! Here’s what happened to Georgia subscriber J.D.: “Four and a half years ago, I was 43 and in the worst shape of my life. At 6’2” I weighed 310 pounds, and the only exercise I got was mowing my yard. I insisted on going out for a fast food lunch every day because I just ‘had to get out of the office,’ and those meals were usually ‘supersized’ so I could get as much food as possible for my money. “I already had hypertension and high cholesterol when a routine physical found a fasting blood sugar of 160 and I was diagnosed with type 2 diabetes. Fortunately for me, my doctor gave me an ultimatum: I could either lose weight or I would have to go on medication for the rest of my life. My wife was determined that I would not take any drugs. We checked out Dr. Whitaker’s book, Reversing Diabetes, and began utilizing many of his techniques. I started exercising and our whole family changed lifestyles. “Today, four years later, I have lost over 100 pounds and it has stayed off. I have never taken medication for diabetes, and my cholesterol and blood pressure are also under control. I walk four miles, four days a week and climb Stone Mountain two days a week. I feel better than I have in years.” Words of Wisdom J.D. ends his letter with this. “I think the secret is that you have to decide that this is not just a ‘diet’ but rather a lifestyle change. You also need the support and encouragement of your family and friends.” J.D. was lucky to have a doctor who told it like it is and a helpful wife. If you don’t have that support, create it. Find a new doctor, join an exercise group, enroll in a weight loss program—the possibilities are endless. Just keep your eye on your goal and remember that, as difficult as changing your diet and exercising may seem, it’s a lot easier than dealing with the inevitable complications of diabesity down the line. Recommendations
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Modified from Health & Healing with permission from Healthy Directions, LLC. Copyright 2007. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here. |
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It is important that you do not reduce, change, or discontinue any medication or treatment without first consulting your physician. Dr. Whitaker offers his recommendations only as "generally informational" and not as specifically applicable to any individual's medical problem(s), concerns, and/or needs.